Health inspection·June 15, 2023

F 0644 assessed for PASARR Level II. Level of Harm - Minimal harm or potential for actual harm Section I Active Diagnoses of the Minimum Data Set (MDS) dated [DATE] showed diagnoses of anxiety disorder, psychotic disorder, schizophrenia, and the resident was not assessed for PASARR Level II. Residents Affected - Some On 06/15/23 at 12:41 p.m., Staff D, Lead MDS Coordinator, reported she was filling in to complete the PASARRs since January 2nd [2023]. She said she created a PASARR if the resident was being admitted from home or did not have the ability to get a PASARR completed. Diagnoses should be listed on the PASARR. Staff D, stated she reviewed medication, history and physical, and psych notes to assist with completing the PASARR. She had never done a referral for a level II PASARR. If a resident had a mental illness, they must have a level II PASARR completed. 4. On 06/12/2023 at 2:00 p.m., Resident #12 was observed lying in bed and receptive to an interview. When approached he appeared comfortable but stated he was having pain to his left heel and asked for two pain pills. He was able to use his call light for assistance. Resident #12 denied getting out of bed daily and stated, I don't want to, and no one is going to make me. Medical record review of the admission Record form revealed Resident #12 was readmitted to the facility on [DATE] with diagnoses listed as social phobia, paranoid schizophrenia, major depression disorder, and anxiety disorder. Review of Resident #12's Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 05/18/2023, Section I Active Diagnoses showed Anxiety disorder, Depression, Psychotic disorder, and Schizophrenia. Review of the Resident #12 Preadmission Screening and Resident Review (PASRR) dated 01/26/2021 showed qualifying mental health diagnoses of Depressive disorder and Schizophrenia and no PASARR Level II was required. The facility failed to complete the PASRR Level II upon a new qualifying mental health diagnosis. Review of the facility's policy titled Resident Assessment-Coordination with PASARR Program implemented 11/28/17 revealed .9. Any resident who exhibits a newly evident or possible serious mental disorder, intellectual disability, or related condition will be referred promptly to the state mental health or intellectual disability authority for a level II resident review . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105551 If continuation sheet Page 2 of 10 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Bradenton 105 15th St E Bradenton, FL 34208 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide care and services to two (Residents#31 and #45) out of two residents sampled for Midline and Peripherally Inserted Central Catheter. Residents Affected - Few Findings included: 1. Review of Resident #45's admission record revealed he was re-admitted on [DATE] from an acute care hospital. His medical diagnoses included but were not limited to chronic osteomyelitis of the right ankle and foot, Type 2 diabetes with foot ulcer, acquired absence of right toe(s), non-pressure chronic ulcer of right ankle with unspecified severity, Methicillin susceptible staphylococcus aureus infection as the cause of diseases, chronic venous hypertension with other complications of bilateral lower extremity. Review of Resident #45's physician orders only revealed an order dated to start on 6/3/23 for Cefazolin sodium reconstituted 1 gram. Use 2 grams intravenously every 8 hours for osteomyelitis until 6/16/23. Further physician review did not reveal any other physician orders related to Resident #45 having an intravenous (IV) catheter. On 6/15/23 at 10:00 a.m., an observation was conducted of Resident #45's right upper arm and revealed he had a IV catheter in place with a clean and intact dressing that was not labeled. The IV catheter observation was conducted with Staff C, RN, minimum data set (MDS) Coordinator. She observed Resident #45's IV catheter dressing and confirmed the dressing was not dated or labeled. Resident #45 stated, they changed the bandage last night and the girl tried to write on it but it wouldn't write Staff C was observed writing 6/14/23 on Resident #45's IV catheter dressing. She stated she was not the person who changed the IV dressing last night. Resident #45 had a care plan initiated on 4/20/23 which revealed I at [sic] risk of complications from IV ABT [antibiotics] for osteomyelitis. Goal included: Infection will resolve without complications. Will minimize risk for complications from IV therapy through the duration of ABT. Interventions include administer meds per orders, consult with ID [infectious disease] as indicated, IV dressing changes per orders, maintain IV patency, observe IV site for s/sx [signs/symptoms] infection: redness, drainage, and irritation. Wound care per MD [medical doctor] orders. An interview was conducted 06/15/23 at 10:17 a.m. with the facility's Director of Nursing (DON). The DON confirmed IV dressings should be dated and labeled when they are changed. He also confirmed Resident #45 is on IV antibiotics for osteomyelitis of his right foot. 2. On 06/14/2023 at 10:38 a.m., Resident #31 was observed sitting in his wheelchair removing a small volume nebulizer mask from his face. As he removed the mask a fine aerosol mist continued to expel into the air. When asked about his breathing treatment he did not respond verbally as cognitive deficit was noted. On 06/14/2023 at 10:40 a.m., Staff B, Licensed Practical Nurse was sitting at the nursing station and was informed Resident # 31 had removed the nebulizer mask. Staff B entered Resident #31 bedroom and turned off nebulizer machine. Resident #31 picked up his left arm as the nurse moved the mask from the bedside table that revealed a catheter device. Staff B confirmed the placement of a catheter to his left upper arm that was dated 06/06/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105551 If continuation sheet Page 3 of 10 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Bradenton 105 15th St E Bradenton, FL 34208 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #31's admission Record form revealed he had resided at the facility for two years. The form did not contain a diagnosis for the placement of the midline catheter. Review of Resident #31's progress notes dated 06/06/2023 at 5:44 p.m. (17:44), showed urinary (UA) results obtained this A.M. MD notified. New order received for Ertapenem (antibiotic) 500 mg intravenous (IV) daily for (x) 10 days for Extended Spectrum Beta-Lactamase (ESBL). Call placed to IV department for midline insertion. At 10:42 p.m. (22:42) Midline inserted to left arm by IV nurse. Review of Physician orders Change midline dressing 24 hours after initial insertion; then weekly on Wednesday every evening shift every Wed dated 06/06/2023. Review of the Treatment Administration Record (TAR) revealed documentation in place that reflected the midline dressing was changed on 06/07/2023. The next scheduled midline dressing change was on 06/14/2023. There was no documentation to show that the dressing change had been done as ordered. On 06/15/2023 at 10:28 a.m., Resident #31 was observed sitting up in his wheelchair and appeared comfortable when approached. His left arm midline dressing just above the antecubital area was no longer occlusive to the skin. The dressing presented with a moderate amount of dried bloody drainage (photographic evidence was obtained). On 06/15/2023 at 10:45 a.m., an interview was conducted with the Director of Nursing (DON) and he confirmed after observation, Resident #31's dressing was dated 06/06/2023. The DON reviewed the TAR that contained documentation that reflected Resident #31's dressing was changed on 06/07/2023. Along with the omission of the dressing change on 06/14/2023. The DON indicated he was unaware Resident #31 had not received care and services to his midline. He confirmed it was his expectation the Licensed nurse's provide care and services as ordered for all vascular/catheter devices. Review of the facility policy titled Vascular Access Devices and Infusion Therapy Procedures dated 08/21. Dressing Change for Vascular Access Devices Purpose: To prevent local and systemic infection related to the IV catheter. Policy: 2. Central venous access device and midline dressing changes will be done at established intervals and immediately if the integrity of the dressing is compromised, if moisture, drainage or blood present, or for further assessment if infection is suspected. Transparent semi-permeable membrane dressing are changed every 7 days and as needed (PRN). 4. Initial dressing are catheter placement will be changed PRN if saturated, and 24-48 hours post insertion of midlines, PICC's, or other central venous access devices if gauze is present under the dressing or/or there is blood/drainage under the dressing. 5. A dressing change is immediately if: The dressing is non-occlusive or soiled. There is drainage or moisture under the dressing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105551 If continuation sheet Page 4 of 10 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Bradenton 105 15th St E Bradenton, FL 34208 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to communicate with the dialysis center for one (Resident #51) out of one resident sampled for dialysis. Residents Affected - Few Findings included: Review of Resident #51's admission record revealed she was admitted on [DATE] from home. Her medical diagnoses included but were not limited to Alzheimer's disease, arteriovenous fistula, end stage renal disease, and dependence on renal dialysis. A family interview was conducted on 6/12/23 at 11:10 a.m. the family stated, [Resident #51] goes to dialysis 3 times a week. Our [family member] takes her and sometimes she [Resident #51] doesn't want to go to dialysis, she has Alzheimer's and we asked her if she wants to stop going but she said she's not ready to die so our family needs to have a meeting about her and what we want to do. An interview was conducted on 06/14/23 at 10:45 a.m. with Staff B, Licensed Practical Nurse (LPN). She said, usually for dialysis residents we take the vitals and complete the top of the communication form, they take the dialysis book with them, and the dialysis center completes their portion. Today [the resident's family member] took the resident [Resident #51] to dialysis he must have forgotten the dialysis book. Normally it is [another family member] that brings her . An interview was conducted on 06/14/23 at 11:00 a.m. with Staff E, LPN. She stated residents who go to dialysis the vitals are documented in the computer, there is a form. We don't use the books anymore. Review of the Resident #51's dialysis communication forms in conjunction with the medical record indicated there was only one communication form for the month of June dated 6/14/23 and the form was incomplete without any post dialysis assessment. An interview with the Director of Nursing (DON) was conducted on 6/15/23 at 10:15 a.m. He stated, the dialysis communication forms should be completed by our nursing staff, sent with the resident to dialysis, and dialysis will email me their information, and then it should be uploaded into the residents medical record. The DON reviewed Resident #51's medical record and her dialysis book and confirmed she did not have any dialysis communication sheets or documentation from the dialysis center in her medical record. Review of Resident #51's care plan initiated on 8/19/21 revealed, [Resident #51] needs hemodialysis r/t [related to] end stage renal failure. M/W/F [Monday/Wednesday/Friday] at [dialysis facility] . family to transport. The goal included the resident will have no s/sx {signs/symptoms] of complications from dialysis through the review date. The interventions included but are not limited to monitor labs and report to doctor as needed. Monitor vital signs pre and post dialysis. Notify MD (medical doctor) of significant abnormalities. Review of the facility's policy hemodialysis with an implantation date of 11/28/2017 revealed Policy Statement (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105551 If continuation sheet Page 5 of 10 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Bradenton 105 15th St E Bradenton, FL 34208 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0698 Level of Harm - Minimal harm or potential for actual harm This facility will provide the necessary care and treatment, consistent with professional standards of practice, physician orders, the comprehensive person-centered care plan, and the resident's goals and preferences, to meet the special medical, nursing, mental, and psychosocial needs of residents receiving hemodialysis. Residents Affected - Few Purpose: The facility will assure that each resident receives care and services for the provision of hemodialysis dialysis consistent with professional standards of practice, which include the following: 1. The ongoing assessment of the resident's condition and monitoring for complications before and after dialysis treatments received at a certified dialysis facility. 2. Ongoing assessment and oversight of the resident before, during, and after dialysis treatments, including monitoring of the resident's condition during treatments, monitoring for complications, implementation of appropriate interventions, and using appropriate infection control practices; and 3. Ongoing communication and collaboration with the dialysis facility regarding dialysis care and services. .Compliance Guidelines: .2. The facility will coordinate and collaborate with the dialysis facility to assure that: a. The resident's needs related to dialysis treatment are met; b. The provision of the dialysis treatments and care of the resident meets current standards of practice for the safe administration of the dialysis treatments; c. Documentation requirements are met to assure that treatments are provided as ordered by the nephrologist, attending practitioner and dialysis team; and d. There is ongoing communication and collaboration for the development and implementation of the dialysis care plan by nursing home and dialysis staff . Review of the facility's Long Term Care Facility Outpatient Dialysis Services Coordination Agreement singed by the facility on 8/14/2019 and signed by the dialysis center on 8/15/2019 revealed .Mutual Obligations (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105551 If continuation sheet Page 6 of 10 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Bradenton 105 15th St E Bradenton, FL 34208 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0698 Level of Harm - Minimal harm or potential for actual harm 11. Collaboration of Care. Both parties shall ensure that there is documentation evidence of collaboration of care and communication between Long Term Care Facility and ESRD [end stage renal disease] Dialysis Unit . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105551 If continuation sheet Page 7 of 10 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Bradenton 105 15th St E Bradenton, FL 34208 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure that the medication error rate was less than 5.00%. Twenty-eight medication administration opportunities were observed, and two errors were identified for two (Residents #136 and #45) out of five sampled residents. These errors constituted a 7.14 % medication error rate. Residents Affected - Few Findings Included: On 06/14/2023 at 11:14 a.m., Staff F, Licensed Practical Nurse, Unit Coordinator entered Resident #136 bedroom and informed him it was time for his blood glucose level. Resident #136 was sitting up in his wheelchair and was receptive to the observation. Staff F performed a blood glucose level (BGL) that registered at 265 milligrams per deciliter (mg/dL). Staff F informed the resident she would return with his insulin. Staff F reviewed Resident #136 orders and stated, the sliding scale indicates 6 units of Aspart. Staff F removed an insulin pen labeled Aspart and cleaned the top of the pen with a alcohol pad and added a new needle. She turned the dose selector to 6 units and stated, See 6 units. Staff F reentered Resident # 136 bedroom and administered the insulin into his left lower abdomen. On 06/15/2023 at 11:25 p.m. Staff H Licensed Practical Nurse, Unit Coordinator was observed as she performed a BGL procedure for Resident # 45 that registered at 199 mg/dL. Staff H returned to the medication cart and stated, his sliding scale indicates he requires 2 units of insulin. Staff H removed a Novolog R pen from the cart and cleaned the top with an alcohol wipe. Placed a new needle on the pen and turned the dial dose to 2 units. Staff H returned to Resident #45 bedroom and administered the insulin to his right upper abdomen. On 06/15/2023 at 12:00 p.m. an interview was conducted with the Director of Nursing that confirmed insulin pens need to be prepared by utilizing the airshot method prior to utilizing. He indicated he was unaware two Licensed staff members failed to perform the air shot method prior to the administration of insulin. The DON confirmed it was his expectation manufactures instructions were followed to ensure residents were receiving the correct amount of insulin. On 06/15/2023 at 2:35 p.m. an interview was conducted with Staff F related to the insulin administered to Resident # 136 she stated, I totally forgot to prepare the insulin pen. On 06/15/2023 at 2:40 p.m. an interview was conducted with Staff H she stated the DON already told me about the insulin pen. I didn't know you had to do that. Review of the facility policy titled Insulin Pen review date 11/23/2022. Policy: It is the policy of this facility to use insulin pens in order to improve the accuracy of insulin dosing. Provide increased resident comfort and serve as a teaching aid to prepare resident for self-administration of insulin therapy upon discharge. Policy Explanation and Compliance Guidelines: 6. Insulin pens will be primed prior to each use to avoid an air of the insulin reservoir. 11. Procedure: h. Prime the insulin pen: i. Dial 2 units by turning the dose selector clockwise. ii. with the needle pointing up, push the plunger, and watch to see that at least one drop of insulin appears on the tip of the needle. If not, repeat until at least one drop appears. i. Set the insulin dose: Turn the dose selector to ordered dose. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105551 If continuation sheet Page 8 of 10 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Bradenton 105 15th St E Bradenton, FL 34208 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow professional standards of practice as it relates to maintaining complete and accurate medical records related to wound care services for one (Resident #45) out of 30 sampled residents. Findings included: Review of Resident #45's admission record revealed he was re-admitted on [DATE] from an acute care hospital. His medical diagnosis included but were not limited to chronic osteomyelitis of the right ankle and foot, Type 2 diabetes with foot ulcer, acquired absence of right toe(s), non-pressure chronic ulcer of right ankle with unspecified severity, Methicillin susceptible staphylococcus aureus infection as the cause of diseases, chronic venous hypertension with other complications of bilateral lower extremity. On 06/12/23 at 10:55 a.m., Resident #45 was observed to have a gauze dressing on his right foot. He stated they were changing it every day and it was getting a teensy bit better. He stated he used to have a wound vacuum (vac) but it kept leaking so he did not have it anymore. Review of Resident #45's minimum data set (MDS), section, C, cognitive patterns, dated 5/22/23 revealed he had a brief interview for mental status (BIMS) score of 14 out of 15 which indicated no cognitive impairment. On 6/15/23 at 10:00 a.m., Resident #45 was observed to have a wound vac in place on his right foot. He stated they just put that on last night. They were changing my bandage every day after the wound vac broke. Review of Resident #45's physician orders revealed an order to start on 6/13/23 without an end date revealed wound vac to right lateral foot and bottom of right foot continuous pressure setting at 125 mmHg, change wound vac 2 times a week (Tuesday-Friday) every day shift every Tuesday, Friday. Review of the June treatment administration record (TAR) revealed the wound vac was documented as competed on 6/13/23. Further physician order dated to start on 5/16/23 without an end date revealed check wound vac for proper functioning every shift. Review of the June TAR documentation revealed the order was signed off as completed on all three shifts from day shift on 6/10/23 thru the night shift on 6/13/23. An interview was conducted 06/15/23 at 10:17 a.m. with the Director of Nursing he stated on Friday [6/10/23] Resident #45's wound vac broke and they ordered a new one. The wound vac came in last night [6/14/23] and was applied. When the wound vac broke, we got an order for wet to dry dressings. The DON reviewed the wound vac documentation for Resident #45 and confirmed the staff should not have been signing off on the wound vac orders because it was not in place from 6/10/23 through the evening of 6/14/23. He stated the orders should have been placed on hold. Review of the facility's policy Documentation in Medical Record implemented on 11/28/2017 revealed Policy Statement (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105551 If continuation sheet Page 9 of 10 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Bradenton 105 15th St E Bradenton, FL 34208 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Each resident's medical record shall contain an accurate representation of the actual experiences of the resident and include enough information to provide a picture of the resident's progress through complete, accurate, and timely documentation . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105551 If continuation sheet Page 10 of 10